WARRIOR, Ala. — The day a 39-year-old surgeon checked into his rustic cabin here at Bradford Health Services, he said he doubted that he could beat his decades-long struggle with alcohol and find joy again in treating patients. Three weeks later, he said, he was convinced otherwise.
It took six weeks for a 54-year-old physician to see a way out of her depression, anxiety and addiction to prescription painkillers. But now she says she's confident and excited to return to practice.
They are among hundreds of physicians from across the country who come to this pine-shaded retreat 25 miles north of Birmingham, where they can get mental-health and addiction treatment without jeopardizing their medical licenses.
Bradford's regimen isn't unique — more than a dozen other addiction centers offer similar programs — but because it works hand in hand with state programs that follow up for five years with drug testing and because doctors can lose their licenses if they relapse, it is extraordinarily effective.
Studies have found that these programs have a success rate of 70 to 90 percent, far higher than the 50 percent rate typical of programs offered to the general population. Researchers believe its rewards-based strategy and extensive follow-up care could help many more of the roughly 20 million Americans who suffer from opioid and other drug and alcohol addictions.
The typical person who is addicted to opioids or other substances relapses multiple times before maintaining long-term sobriety, even when treated with highly effective medications and evidence-based behavioral therapies. In an opioid epidemic that is killing about 145 Americans every day, according to preliminary estimates for 2016, finding effective addiction treatment can make the difference between life and death.
More than 1 in 10 doctors becomes addicted to drugs or alcohol, a slightly higher rate than in the general population. Burnout, a recognized problem in the medical professions, and the easy availability of drugs probably make addiction more common among doctors.
Nearly all states allow doctors to complete specialized treatment plans — such as an in-patient stay at Bradford or a similar facility — rather than lose their license because of a mental health condition or drug or alcohol addiction, or both.
In addition to the program for health care professionals, which includes dentists, nurses, pharmacists and veterinarians, Bradford offers treatment for lawyers, pilots, first responders and athletes.
Working with state medical licensing boards, physician health programs are typically funded through medical licensing fees, grants and private donations. Bradford treats about 120 physicians annually, at a cost of $25,000 to $42,000 per person.
In some cases, doctors who suspect they have a mental-health problem or addiction that may be affecting their work seek help from the programs on their own. But most physicians who enroll do so after being told by an employer, licensing authority or the Drug Enforcement Administration to seek treatment if they want to keep their medical license.
The first step is a mental and behavioral health assessment. Next, doctors sign a contract with Bradford agreeing to complete four to 12 weeks of residential treatment and to submit to five years of monitoring.
If a doctor relapses after treatment, his or her license may be suspended. And if the relapse raises concerns of patient endangerment, the license can be revoked.
According to a 2009 survey of close to 40 program directors, nearly 80 percent of doctors remained sober throughout the five-year program, and 70 percent continued to practice medicine.
Robert DuPont, a co-author of the survey and a former White House drug czar under President Richard Nixon, maintains that a key principle of the program can be effectively applied to other people with addiction.
It's not that most physicians are affluent, highly motivated and compliant, he said. The secret to the program's success is the way it manages relapses using swift and meaningful consequences, DuPont said.
For doctors to remain sober after they return to high-stress jobs with easy access to controlled substances, there has to be a big payoff. For physicians, the reward is huge — keeping a medical license that cost them hundreds of thousands of dollars and years of their lives to obtain.
Lynn Hankes, a former director of Washington state's physician health program, said another critical ingredient is the five years of random drug tests and follow-up support. Most people who undergo treatment get no follow-up care, he said.
Doctors tend to be compliant and to believe in the evidence that backs up the treatment program, but they're used to being in charge, said Michael Wilkerson, Bradford's medical director. Following someone else's rules isn't always easy for them.
"When they first get into treatment, they do it because they feel the heat," he said. "If they're going to stay in recovery, they need to see the light. They need to buy into the benefits of recovery."
Linda Bresnahan, director of the Federation of State Physician Health Programs, noted that physicians who complete a treatment and monitoring program are better equipped to handle stress and less likely to endanger patients. A study in Occupational Medicine showed that more than 800 doctors who graduated from Colorado's physician health program between 1983 and 2010 had a lower malpractice risk rating than other physicians.
Most physician health programs are 12-step or similar regimens that call for abstinence, in part because many state medical boards have concerns about allowing doctors to practice if they are taking maintenance drugs such as methadone and buprenorphine.
In October, doctors came to Bradford's site outside Birmingham, leaving behind jobs and families in Arkansas, California, Georgia, Massachusetts, Mississippi, North Carolina, Oklahoma and West Virginia, as well as other parts of Alabama.
The 39-year-old surgeon who had been pessimistic about treatment said he was ready to quit practicing medicine when a colleague told him about the physician health program. His wife had filed for divorce, he was depressed, and he said his way of dealing with stress was to throw himself into his work and drink heavily on his days off. "I seriously considered suicide," he said.
The 54-year-old doctor who got treatment for her addiction to painkillers at Bradford saw a pain specialist who put her on a non-opioid drug that's helping her neck and shoulder pain. She, too, had been ready to stop being a doctor, she said, but with a big balance left on her medical school loan, she said she couldn't afford to.
As for the five years of random drug screenings they face, both physicians, now confident they can continue doctoring, said they weren't worried.
"This is a lifelong deal. I know that," said the surgeon, who began suffering from depression at age 14. "But for the first time in at least 25 years, there's hope that I don't have to go on living the way I've been living."